Acute gastroenteritis: Difference between revisions
(viral, staph) |
(noninvasive) |
||
| Line 30: | Line 30: | ||
|| Yes | || Yes | ||
|- | |- | ||
| [[Bacillus cereus|B. cereus]]|| 1-6 hrs|| | | [[Bacillus cereus|B. cereus]] | ||
|| 1-6 hrs | |||
|| | |||
*Abrupt onset of nausea, vomiting, mild diarrhea | |||
|| | |||
*Previously cooked foods (rice, vegetables, dried fruits, meat) | |||
|| Yes | |||
|- | |- | ||
| [[Clostridium (not difficile)|C. perfringens]]|| 8-24 hrs|| | | [[Clostridium (not difficile)|C. perfringens]] | ||
|| 8-24 hrs | |||
|| | |||
*Nausea, minimal vomiting, watery diarrhea | |||
*Abd cramps | |||
|| | |||
*Previously cooked or reheated meats and poultry | |||
|| Yes | |||
|- | |- | ||
| [[Vibrio cholera|V. cholerae]]|| 11-72 hrs || | | [[Vibrio cholera|V. cholerae]]|| 11-72 hrs || | ||
*Explosive rice-water diarrhea | |||
*Vomiting, abd cramps | |||
*Fever | |||
|| | |||
*Fecal-oral | *Fecal-oral | ||
*Contaminated food or water | *Contaminated food or water | ||
|| No | |||
|- | |- | ||
| [[Giardia]]|| 1-4 wks|| | | [[Giardia]] | ||
|| 1-4 wks | |||
|| | |||
*Flatus, bloating | |||
*Foul-smelling and fatty stools (steatorrhea) | |||
|| | |||
*Fecal-oral | |||
*Contaminated water | |||
|| No | |||
|} | |} | ||
Revision as of 05:58, 31 October 2015
Background
- Blood diarrhea suggests bacterial etiology
- Viral AGE usually lasts <7d
- Do not dx isolated vomiting as AGE
Causes
| Species | Onset | Symptoms | Transmisison | Preformed Toxin |
|---|---|---|---|---|
| Viral | 11-72 hrs |
|
|
No |
| Staph | 1-6 hrs |
|
|
Yes |
| B. cereus | 1-6 hrs |
|
|
Yes |
| C. perfringens | 8-24 hrs |
|
|
Yes |
| V. cholerae | 11-72 hrs |
|
|
No |
| Giardia | 1-4 wks |
|
|
No |
| Species | Onset | Symptoms | Transmission |
|---|---|---|---|
| Salmonella | 6-72 hours |
| |
| Shigella | 1-3 days |
|
|
| Yersinia | 1-5 days |
|
|
| Campylobacter | 1-7 days |
|
|
| C. Diff | 1-11 Weeks |
|
|
| Entamoeba | 1-11 weeks |
|
Clinical Features
- Vomiting/diarrhea
- Crampy/diffuse abdominal pain
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Diagnosis
- Assess hydration status
- Cap refill, skin turgor, resp rate
- Consider stool labs if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Fever
- Bloody stool
- Persistent diarrhea
Treatment
- Oral rehydration therapy
- 30mL(1oz)/kg/hr
- Antiemetic
- Ondansetron 0.15mg/kg/dose IV/PO
- Antibiotics
- Only consider in pts w/ invasive infection
- Shigella, campylobacter, E. coli, yersinia, vibrio
- Bloody stool with mucus and fever
- NOT indicated for E. coli O157:H7
- NOT routinely indicated for salmonella
- Exceptions: SCD, IBD, <3mo
- Azithromycin (able to tolerate PO)
- Ceftriaxone (parenteral)
- Only consider in pts w/ invasive infection
